| NPI | 1801025721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 53801) |
| Additional Taxonomies | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: MA 53801) |
| Enumeration Date | 2009-07-13 |
| Last Update Date | 2009-07-13 |